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Chen J, Chen J, Hu J, Huang R, Shen L, Gu H, Chai X, Wang D. Cigarette smoking is linked to an increased risk of delirium following arthroplasty in patients suffering from osteoarthritic pain. CNS Neurosci Ther 2023; 29:3854-3862. [PMID: 37334739 PMCID: PMC10651961 DOI: 10.1111/cns.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
AIMS Postoperative delirium (POD) is a common postoperative complication, and the potential relationship between cigarette smoking and POD is still unclear. The current study evaluated the relationship between preoperative smoking status in patients suffering from osteoarthritic pain and POD after total knee arthroplasty (TKA). METHODS A total of 254 patients who had undergone unilateral TKA were enrolled between November 2021 and December 2022, with no gender limitation. Preoperatively, patients' visual analog scale (VAS) scores at rest and during movement, hospital anxiety and depression (HAD) scores, pain catastrophizing scale (PCS) scores and smoking status were collected. The primary outcome was the incidence of POD, which was evaluated by the confusion assessment method (CAM). RESULTS A total of 188 patients had complete datasets for final analysis. POD was diagnosed in 41 of 188 patients (21.8%) who had complete data for analysis. The incidence of smoking was significantly higher in Group POD than in Group Non-POD (22 of 41 patients [54%] vs. 47 of 147 patients [32%], p < 0.05). The postoperative hospital stays were also longer than those of Group Non-POD (p < 0.001). Multiple logistic regression analysis showed that preoperative smoking (OR: 4.018, 95% CI: 1.158-13.947, p = 0.028) was a risk factor for the occurrence of POD in patients with TKA. The length of hospital stay was correlated with the occurrence of POD. CONCLUSIONS Our findings suggest that patients who smoked preoperatively were at increased risk of developing POD following TKA.
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Affiliation(s)
- Jie‐ru Chen
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Jia‐qi Chen
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Ji‐cheng Hu
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Run‐sheng Huang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Liang Shen
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Hai Gu
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Xiao‐qing Chai
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Di Wang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTCDivision of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
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2
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Boissoneault J, Stennett-Blackmon B, Gilmour C, Blaes S. Neural and Psychosocial Mechanisms Underlying Alcohol Use and Pain Interactions: Overview of Current Evidence and Future Directions. CURRENT ADDICTION REPORTS 2023; 10:677-689. [PMID: 38645279 PMCID: PMC11031255 DOI: 10.1007/s40429-023-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 04/23/2024]
Abstract
Purpose of Review A growing body of research indicates bidirectional associations between alcohol use and pain. In this review, we highlight common neural and psychosocial mechanisms underlying pain and alcohol use and identify current gaps in the literature regarding alcohol/pain interactions. We also suggest future directions for the field moving forward, including more nuanced conceptualization of alcohol's negative reinforcing effects in the context of pain, broader use of clinically-relevant experimental pain induction modalities, and characterization of age, biological sex, gender, race, and ethnicity as moderators of pain/alcohol interactions. Recent Findings Acute alcohol intake has analgesic and negative-reinforcing effects in the context of pain, and chronic heavy alcohol use appears to increase risk for development of chronic pain. At the same time, pain, both acute and chronic, acts as a proximal antecedent for alcohol use and is associated with relapse risk for individuals in recovery from alcohol use disorder. Summary Although the links between alcohol use and pain are increasingly appreciated, significant gaps in understanding remain and systematic study of alcohol/pain interactions at all levels, including basic, preclinical, translational, and interventional, is needed.
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Affiliation(s)
- Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Bethany Stennett-Blackmon
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Christina Gilmour
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Shelby Blaes
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
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3
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Powers JM, Zale EL, Deyo AG, Rubenstein D, Terry EL, Heckman BW, Ditre JW. Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study. J Racial Ethn Health Disparities 2023; 10:2407-2416. [PMID: 36171497 PMCID: PMC10651305 DOI: 10.1007/s40615-022-01419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, 13902, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Ellen L Terry
- Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, 32610, USA
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, USA
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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4
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Iida H, Yamaguchi S, Goyagi T, Sugiyama Y, Taniguchi C, Matsubara T, Yamada N, Yonekura H, Iida M. Consensus statement on smoking cessation in patients with pain. J Anesth 2022; 36:671-687. [PMID: 36069935 PMCID: PMC9666296 DOI: 10.1007/s00540-022-03097-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.
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Affiliation(s)
- Hiroki Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan. .,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. .,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan.
| | - Shigeki Yamaguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Toru Goyagi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Akita University Hospital, Akita, Japan
| | - Yoko Sugiyama
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Woman Doctor Active Support in Perioperative Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan
| | - Chie Taniguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,College of Nursing, Aichi Medical University, Nagakute, Japan
| | - Takako Matsubara
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe , Japan
| | - Naoto Yamada
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Iwate Medical University Hospital, Iwate, Japan
| | - Hiroshi Yonekura
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mami Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
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5
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Robinson CL, Kim RS, Li M, Ruan QZ, Surapaneni S, Jones M, Pak DJ, Southerland W. The Impact of Smoking on the Development and Severity of Chronic Pain. Curr Pain Headache Rep 2022; 26:575-581. [PMID: 35731364 DOI: 10.1007/s11916-022-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the impact of smoking and its role on the development of chronic pain and provide a critical review of recent literature. RECENT FINDINGS Recent studies demonstrate the bidirectional and dependent relationship between smoking and chronic pain. Those who are in pain have a more difficult time in the cessation of smoking as well as an increased sensitivity to pain during abstinence, lower confidence, and higher relapse rates. The fear of pain and the anxiety and depression that abstinence causes results in a grim outcome for long-term cessation. The dependent nature between chronic pain and smoking is affected by numerous variables. Providers should consider a multiprong approach to treating chronic pain and targeting smoking cessation treatment by providing motivational therapy, nicotine replacement, and medication therapies to prevent relapse, and providing those who are more likely to relapse with a higher level of care.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Rosa S Kim
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Michael Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Sindhuja Surapaneni
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Mark Jones
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Daniel J Pak
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Warren Southerland
- Department of Anesthesia, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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6
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Zale EL, Maisto SA, De Vita MJ, Hooten WM, Ditre JW. Increasing cessation motivation and treatment engagement among smokers in pain: A pilot randomized controlled trial. Exp Clin Psychopharmacol 2021; 29:593-604. [PMID: 32757595 PMCID: PMC8499853 DOI: 10.1037/pha0000424] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tobacco smokers with co-occurring pain report greater difficulty quitting, face unique cessation challenges, and may benefit from targeted smoking interventions. We developed and tested a brief motivational intervention aimed at increasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers in pain. Nontreatment seeking daily cigarette smokers with chronic pain (N = 76, 57.9% women, 52.6% White) were randomized to the targeted or ask, advise, refer (AAR) intervention. The targeted intervention included personalized feedback and pain-smoking psychoeducation to help participants develop discrepancy between continued smoking and desired pain outcomes. At postintervention, the targeted intervention (vs. AAR) increased knowledge of pain-smoking interrelations and several indices of motivation to quit smoking (ps < .01). Participants who received the targeted intervention were also more likely to accept information about and report intention to engage evidence-based cessation treatments (ps < .05). Increased knowledge of pain-smoking interrelations mediated postintervention effects on motivation to quit and willingness to learn about treatments. At 1-month follow up, gains in knowledge of pain-smoking interrelations were maintained (p = .009). Participants who received the targeted intervention were more likely to report having subsequently engaged cessation treatment (p = .019), but this was not mediated by increased knowledge of pain-smoking interrelations. Smokers with chronic pain may benefit from targeted interventions that address smoking in the context of pain. Smokers in pain may become increasingly motivated to quit and engage cessation treatment as they become aware of how smoking may exacerbate their pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - W. Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine
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7
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Bastian LA, Driscoll M, DeRycke E, Edmond S, Mattocks K, Goulet J, Kerns RD, Lawless M, Quon C, Selander K, Snow J, Casares J, Lee M, Brandt C, Ditre J, Becker W. Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain. Contemp Clin Trials Commun 2021; 23:100839. [PMID: 34485755 PMCID: PMC8391053 DOI: 10.1016/j.conctc.2021.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results The 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.
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Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Eric DeRycke
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Sara Edmond
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Kristin Mattocks
- University of Massachusetts Medical School, Worcester, MA, United States.,VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Joe Goulet
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mark Lawless
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Caroline Quon
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Kim Selander
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer Snow
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jose Casares
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Megan Lee
- Yale University School of Medicine, New Haven, CT, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - William Becker
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
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8
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I smoke to cope with pain: patients' perspectives on the link between cigarette smoking and pain. Wien Klin Wochenschr 2021; 133:1012-1019. [PMID: 34460005 DOI: 10.1007/s00508-021-01931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized a reciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association. METHODS A retrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, a tailored smoking cessation trial, was conducted. A validated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in a consensus-forming exercise with salient themes validated among the wider research team. KEY RESULTS Participants averaged 60 years of age (range 28-77 years) and were 9% female. The median number of cigarettes smoked per day was 15, with a mean pain intensity score in the last week (from 0-10) of 5.1. While not all patients acknowledged a connection between pain and smoking, we found that (1) pain motivates smoking and helps manage pain-related distress, as a coping strategy and through cognitive distraction, and (2) pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as a notable barrier to cessation. CONCLUSION Many patients with chronic pain who smoke readily identified pain as a motivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain.
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Croghan IT, Hurt RT, Ganesh R, Bhagra O, Fischer KM, Vincent A, Hays JT, Bierle DM, Schroeder DR, Fuehrer DL, Nanda S. The Association of Current Tobacco Status With Pain and Symptom Severity in Fibromyalgia Patients. Mayo Clin Proc Innov Qual Outcomes 2021; 5:614-624. [PMID: 34195553 PMCID: PMC8240153 DOI: 10.1016/j.mayocpiqo.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To describe current tobacco use among patients with newly confirmed fibromyalgia and evaluate the association between tobacco use status and severity of reported pain and other fibromyalgia symptoms. Patients and Methods Participants in this study were adult patients (N=1068) with fibromyalgia who met American College of Rheumatology 2010/2011 clinical criteria for fibromyalgia at the time of initial presentation to a Midwest fibromyalgia clinic (June 1, 2018, through May 31, 2019). Multiple linear regression analyses were performed to assess the association of tobacco use status with the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores. Covariates included in these analyses included age, sex, body mass index, depression, opioid medication use, and use of fibromyalgia-specific pharmacotherapy. Results The patients were largely women (87.0%; n=929), white (87.9%; n=939), and with an average ± SD age of 46.6±13.9 years. The WPI and SSS scores were significantly greater in current tobacco users compared with never tobacco users (WPI effect estimate [EE] = 1.03; 95% CI, 0.30 to 1.76; type III P=.020; SSS EE = 0.47; 95% CI, 0.11 to 0.84; type III P=.036). The WPI score was negatively associated with age (EE = −0.02 per year; 95% CI, −0.03 to −0.001 per year; P=.037) and no use of opioid medication (EE = −1.08; 95% CI, −1.59 to −0.57; P<.001) while positively associated with higher body mass index (EE = 0.03 per 1 kg/m2; 95% CI, 0.001 to 0.06 per kg/m2; P=.04) and higher Patient Health Questionnaire-9 score (EE = 0.12; 95% CI, 0.08 to 0.16; P<.001). Conclusion The results of our study suggest that tobacco use is associated with greater pain and other symptom severity in patients with fibromyalgia. These findings have important clinical and research implications for patients with fibromyalgia who use tobacco and who may benefit from early identification and timely implementation of tobacco cessation treatment to decrease pain and improve overall quality of life.
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Affiliation(s)
- Ivana T Croghan
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ryan T Hurt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ravindra Ganesh
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ojas Bhagra
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ann Vincent
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - J Taylor Hays
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Dennis M Bierle
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Debbie L Fuehrer
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Sanjeev Nanda
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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10
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Smuck M, Schneider BJ, Ehsanian R, Martin E, Kao MCJ. Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain. PAIN MEDICINE 2021; 21:1759-1768. [PMID: 31578562 DOI: 10.1093/pm/pnz224] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Examine the interrelationship between smoking and pain in the US population. DESIGN A cross-sectional population-based study. SETTING Nationwide survey. METHODS Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions. RESULTS Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73). CONCLUSIONS Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.
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Affiliation(s)
- Matthew Smuck
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Vanderbilt University Medical Center, Center for Musculoskeletal Research
| | - Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Department of Neurosurgery, Stanford University, Palo Alto, California.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Elizabeth Martin
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee.,Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ming-Chih J Kao
- Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
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11
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Gold AK, Otto MW, Hoyt DL, Garey L, Smit T, Zvolensky M. Do Pain-Related Anxiety and Difficulties With Emotion Regulation Impact Abstinence Expectancies or Motivation to Quit E-Cigarette Use? J Stud Alcohol Drugs 2021; 82:414-421. [PMID: 34100710 PMCID: PMC8328231 DOI: 10.15288/jsad.2021.82.414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/15/2020] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Pain-related anxiety is a psychologically based construct that is associated with tobacco dependence and may have important relevance to e-cigarette use. Difficulties with emotion regulation, a relevant construct in motives for cigarette smoking, may interact with pain-related anxiety to yield worsened clinical outcomes among e-cigarette users. We evaluated whether pain-related anxiety and difficulties with emotion regulation independently and in interaction predict e-cigarette users' expectancies surrounding abstinence and their motivation to stop using e-cigarettes. METHOD Daily e-cigarette users (n = 290, mean age= 35.5, SD = 10.9, 56.6% male) completed an online survey about e-cigarette use. We conducted hierarchical multiple regression analyses to evaluate the main and interactive influence of pain-related anxiety and difficulties with emotion regulation on our outcomes. RESULTS Increased pain-related anxiety independently predicted negative abstinence expectancies and increased motivation to quit e-cigarette use (ps < .001). Increased difficulties with emotion regulation predicted only negative abstinence expectancies (ps < .01) when pain-related anxiety was included in the model. The interaction between pain-related anxiety and difficulties with emotion regulation was not significant. CONCLUSIONS As hypothesized, increased pain-related anxiety was associated with both negative expectancies of abstinence and increased motivation to quit e-cigarette use, but contrary to our hypothesis, difficulties with emotion regulation were not significantly associated with increased motivation to quit e-cigarette use when evaluated with pain-related anxiety in the model. These findings may elucidate processes influencing abstinence expectancies and motivation to quit in a sample of e-cigarette users, although replication in a larger, more diverse sample is warranted.
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Affiliation(s)
- Alexandra K. Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Danielle L. Hoyt
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas
| | - Michael Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Alexander AC, Waring JJC, Hébert ET, Ra CK, Rangu N, Kendzor DE, Businelle MS. Identifying mechanisms that link pain to smoking relapse during a quit attempt. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:52-61. [PMID: 33719473 DOI: 10.1037/adb0000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Emerging evidence suggests that adults with chronic pain have poor smoking cessation outcomes, but the exact mechanisms are less understood. This study examined whether depression, anxiety, stress, and then, positive outcome expectancy for smoking mediated the association between pain and smoking relapse during a quit attempt. METHODS This study is a secondary data analysis of a three-armed randomized clinical trial that compared in-person and smartphone-based smoking cessation interventions. Participants (N = 81) self-reported the amount of bodily pain they experienced in the past 4 weeks at baseline. Depression, anxiety, stress, and positive outcome expectancy for smoking were measured daily, via a smartphone app, throughout the first week of the quit attempt, and were aggregated to the week level for analyses. Biochemically verified smoking abstinence was assessed 4 weeks postquit date. RESULTS Sequential mediation analyses showed that pain was indirectly associated with smoking relapse through greater feelings of stress and then higher expectations that smoking would improve mood (B = 0.22 [95% CI = 0.03, 0.65]). The pathways for depression and anxiety were not significant mediators of pain and smoking relapse. CONCLUSION Findings from this study indicate that pain is indirectly associated with smoking relapse through feelings of stress and then positive outcome expectancy for smoking. Smoking cessation treatment for adults who experience high levels of bodily pain should include psychoeducation that teaches adaptive coping responses, such as mindfulness, to manage stress, and challenge expectations about the ability of smoking to improve mood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Adam C Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Joseph J C Waring
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Chaelin Karen Ra
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Neal Rangu
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
| | - Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center
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13
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Powers JM, LaRowe LR, Garey L, Zvolensky MJ, Ditre JW. Pain intensity, e-cigarette dependence, and cessation-related outcomes: The moderating role of pain-related anxiety. Addict Behav 2020; 111:106548. [PMID: 32745941 PMCID: PMC7484173 DOI: 10.1016/j.addbeh.2020.106548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Pain and nicotine dependence are prevalent, co-occurring conditions posited to interact in the manner of a positive feedback loop; however, most research to date has been conducted among tobacco cigarette smokers. Initial evidence suggests that pain is a risk factor for greater e-cigarette dependence, and additional research is needed to examine covariation between pain and e-cigarette use. There is reason to suspect that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with greater e-cigarette dependence and difficulty quitting, and that pain intensity and pain-related anxiety may interact to confer greater risk for e-cigarette use. The current study represents the first examination of cross-sectional associations between pain intensity, pain-related anxiety, and e-cigarette dependence, motivation to quit, history of lifetime e-cigarette quit attempts, perceived barriers to cessation, and negative expectancies during abstinence from e-cigarettes. Participants (N = 520 e-cigarette users, 52.1% female, Mage = 34.85) completed an online survey assessing health behaviors. Results indicated that pain-related anxiety was positively associated with e-cigarette dependence and perceived barriers to cessation (ps < 0.05). Pain-related anxiety was found to moderate relations between pain intensity and primary outcomes, such that pain intensity was positively associated with motivation to quit, likelihood of past failed quit attempt, and negative abstinence expectancies among participants who endorsed high (but not moderate or low) levels of pain-related anxiety. Future research would benefit from examining prospective associations between pain-related anxiety, pain intensity, and e-cigarette use/cessation trajectories among individuals with chronic pain.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Lisa R LaRowe
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, USA
| | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA.
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14
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Villarreal YR, Stotts AL, Paniagua SM, Rosen K, Eckmann M, Suchting R, Potter JS. Mindfulness predicts current risk of opioid analgesic misuse in chronic low back pain patients receiving opioid therapy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Parkerson HA, Sareen J, Asmundson GJG. Breaking the cycle of smoking and pain: do pain-related anxiety and pain reduction expectancies sabotage attempts to quit smoking and can smoking cessation improve pain and pain-related disability outcomes? Cogn Behav Ther 2020; 50:154-171. [PMID: 32852241 DOI: 10.1080/16506073.2020.1798498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Contemporary models of smoking and pain suggest a reciprocal and self-perpetuating cycle, wherein smoking reduces pain in the short term but indirectly exacerbates pain in the long term. In a sample of participants engaged in an active smoking-cessation attempt, this investigation assessed a) whether specific smoking risk factors (i.e., smoking expectancies for pain reduction, pain-related anxiety) acted as barriers to cessation, and b) whether breaking the smoking-pain cycle through successful smoking abstinence impacted pain and pain-related disability outcomes for participants with pain. Participants comprised 168 smokers (44.4% with pain) who engaged in an online smoking-cessation program. Pain-related anxiety, but not smoking expectancies, accounted for a significant proportion of variance of smoking dependence from pre- to post-intervention. Results suggest that pain-related anxiety is a risk factor for maintained smoking dependence for all smokers regardless of pain status. Participants with pain who successfully quit smoking experienced statistically and clinically meaningful decreases in pain and pain-related disability from pre- to post-intervention. Exploratory post hoc analyses indicated that individuals who signed-up for the smoking cessation program but failed to begin a quit-attempt had significantly higher pain disability, depression, and anxiety scores than participants who commenced a quit-attempt. Theoretical and practical implications are discussed.
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Affiliation(s)
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba , Winnipeg, Canada
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16
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Affiliation(s)
- Lisa R. LaRowe
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
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17
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Delery EC, Edwards S. Neuropeptide and cytokine regulation of pain in the context of substance use disorders. Neuropharmacology 2020; 174:108153. [PMID: 32470337 DOI: 10.1016/j.neuropharm.2020.108153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Abstract
Substance use disorders (SUDs) are frequently accompanied by affective symptoms that promote negative reinforcement mechanisms contributing to SUD maintenance or progression. Despite their widespread use as analgesics, chronic or excessive exposure to alcohol, opioids, and nicotine produces heightened nociceptive sensitivity, termed hyperalgesia. This review focuses on the contributions of neuropeptide (CRF, melanocortin, opioid peptide) and cytokine (IL-1β, TNF-α, chemokine) systems in the development and maintenance of substance-induced hyperalgesia. Few effective therapies exist for either chronic pain or SUD, and the common interaction of these disease states likely complicates their effective treatment. Here we highlight promising new discoveries as well as identify gaps in research that could lead to more effective and even simultaneous treatment of SUDs and co-morbid hyperalgesia symptoms.
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Affiliation(s)
- Elizabeth C Delery
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Scott Edwards
- Department of Physiology and Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA.
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18
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Cáceres-Matos R, Gil-García E, Barrientos-Trigo S, Porcel-Gálvez AM, Cabrera-León A. Consequences of Chronic Non-Cancer Pain in adulthood. Scoping Review. Rev Saude Publica 2020; 54:39. [PMID: 32321056 PMCID: PMC7135143 DOI: 10.11606/s1518-8787.2020054001675] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine and map the consequences of chronic pain in adulthood. METHOD Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included RESULTS Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning. CONCLUSIONS This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities.
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Affiliation(s)
- Rocío Cáceres-Matos
- Universidad de Sevilla. Facultad de Enfermería, Fisioterapia y Podología. Departamento de Enfermería. Sevilla, España
| | - Eugenia Gil-García
- Universidad de Sevilla. Facultad de Enfermería, Fisioterapia y Podología. Departamento de Enfermería. Sevilla, España
| | - Sergio Barrientos-Trigo
- Universidad de Sevilla. Facultad de Enfermería, Fisioterapia y Podología. Departamento de Enfermería. Sevilla, España
| | - Ana María Porcel-Gálvez
- Universidad de Sevilla. Facultad de Enfermería, Fisioterapia y Podología. Departamento de Enfermería. Sevilla, España
| | - Andrés Cabrera-León
- Escuela Andaluza de Salud Pública. Granada, España.,Centro de Investigación Biomédica en Red de Salud Pública y Epidemiología (CIBERESP). Madrid, España.,Universidad de Granada. Instituto de Investigación Biosanitaria, ibs. Hospitales Universitarios de Granada. Granada, España
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19
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Pain-related anxiety and smoking processes: The explanatory role of dysphoria. Addict Behav 2019; 88:15-22. [PMID: 30103097 PMCID: PMC10062193 DOI: 10.1016/j.addbeh.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 11/21/2022]
Abstract
Scientific evidence suggests that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers with varying levels of pain. Yet, no work has investigated the relation between pain-related anxiety and cognitive-based smoking processes within an indirect effect model. Dysphoria may explain the relation between pain-related anxiety and cigarette smoking, as it is a construct that relates to both pain and smoking outcomes. Thus, the current cross-sectional study examined the indirect effect of pain-related anxiety and three clinically significant smoking processes: perceived barriers to cessation, negative affect reduction motives, and negative mood abstinence expectancies via dysphoria. Participants included 101 (Mage = 32.74 years, SD = 13.60; 35.6% female) adult tobacco cigarette smokers with low cigarette dependence. Results indicated that pain-related anxiety had an indirect effect on all dependent variables through dysphoria. The current findings provide evidence that dysphoria may serve to maintain maladaptive smoking processes in smokers who experience pain-related anxiety. This study furthers research on pain-smoking relations by providing initial evidence for a conceptual model in which smokers with elevated pain-related anxiety endorse greater dysphoric symptoms and use smoking to reduce or escape symptoms of their pain-related anxiety and dysphoria, thus contributing to the maintenance of tobacco dependence.
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20
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Ditre JW, Zale EL, LaRowe LR. A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions. Annu Rev Clin Psychol 2018; 15:503-528. [PMID: 30566371 DOI: 10.1146/annurev-clinpsy-050718-095440] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York 13902, USA;
| | - Lisa R LaRowe
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
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21
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Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference. Pain Rep 2018; 3:e700. [PMID: 30706040 PMCID: PMC6344139 DOI: 10.1097/pr9.0000000000000700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction: Chronic pain in late adolescence and young adults is understudied and poorly characterized. Objectives: We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity. Methods: Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference. Results: Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference. Conclusion: Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.
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22
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LaRowe LR, Chilcott LN, Zvolensky MJ, Vanable PA, Flood K, Ditre JW. Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS. Subst Use Misuse 2018; 53:2210-2219. [PMID: 29708450 PMCID: PMC6126665 DOI: 10.1080/10826084.2018.1464028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse. OBJECTIVES This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females). METHODS Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications. RESULTS There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.
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Affiliation(s)
| | | | | | | | - Kelley Flood
- Immune Health Services, Upstate Medical University
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23
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LaRowe LR, Zvolensky MJ, Ditre JW. The Role of Anxiety-Relevant Transdiagnostic Factors in Comorbid Chronic Pain and Tobacco Cigarette Smoking. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9957-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Driscoll MA, Perez E, Edmond SN, Becker WC, DeRycke EC, Kerns RD, Bastian LA. A Brief, Integrated, Telephone-Based Intervention for Veterans Who Smoke and Have Chronic Pain: A Feasibility Study. PAIN MEDICINE 2018; 19:S84-S92. [PMID: 30203011 DOI: 10.1093/pm/pny144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective High rates of co-occurring smoking and chronic pain are observed in the veteran population. Individuals who smoke and have chronic pain report lower self-efficacy to quit and are less successful in their attempts. Design In this pilot study, we assess the feasibility of a telephone-delivered intervention designed to integrate evidence-based smoking cessation and pain management components in a way that allows patients to understand the interplay between the two while attempting to have them build off each other and develop coping skills to address both concerns. Patients Study participants (N = 7) were veterans who received primary care in the VA Healthcare System and reported current smoking and a worst pain intensity score of 4 or greater. Intervention A five-session telephone intervention was delivered over eight weeks. Participants completed a survey at baseline and 10-week follow-up. Outcome Measures Feasibility was assessed by examining engagement with the intervention. Results Four out of seven participants completed all five sessions. Two out of seven veterans reported quitting smoking, and five out of seven reported clinically meaningful improvements in pain intensity and functional interference. Conclusions Insights gained from this study were used to modify an intervention being examined in a randomized controlled trial to test its effectiveness on both smoking and pain outcomes.
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Affiliation(s)
- Mary A Driscoll
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Elliottnell Perez
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut
| | - Sara N Edmond
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut, USA
| | - William C Becker
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric C DeRycke
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut
| | | | - Lori A Bastian
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut, USA
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25
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Smoking Status and Opioid-related Problems and Concerns Among Men and Women on Chronic Opioid Therapy. Clin J Pain 2018; 33:730-737. [PMID: 27898458 DOI: 10.1097/ajp.0000000000000461] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Smokers on chronic opioid therapy (COT) for noncancer pain use prescription opioids at higher dosages and are at increased risk for opioid misuse and dependence relative to nonsmokers. The current study aims to assess whether smoking is associated with problems and concerns with COT from the perspective of the patient. MATERIALS AND METHODS In a large sample (N=972) of adult patients prescribed opioids for chronic noncancer pain, we examined sex-specific associations between smoking status and patient perceptions of problems and concerns with COT using regression analyses, adjusting for covariates. RESULTS The sample self-identified as 27% current smokers, 44% former smokers, and 29% never smokers. Current smoking (vs. never smoking) was associated with increased odds of an opioid use disorder among males and females, and higher daily opioid dose among males only. Current and former smokers reported significantly fewer problems with opioids relative to never smokers, and this was driven primarily by lower endorsement of problems that are affected by the stimulant properties of nicotine (eg, difficulties thinking clearly, felt less alert or sleepy). DISCUSSION This study contributes to an understanding of perceived problems and concerns with COT among current, former, and never smokers with chronic noncancer pain. Results suggest that current and former smokers may be a difficult population to target to decrease COT, given that they perceive fewer problems with prescription opioid use, despite higher odds of having an opioid use disorder (males and females) and greater opioid doses (males only).
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Tarantola ME, Heath AC, Sher KJ, Piasecki TM. WISDM Primary and Secondary Dependence Motives: Associations With Smoking Rate, Craving, and Cigarette Effects in the Natural Environment. Nicotine Tob Res 2018; 19:1073-1079. [PMID: 28182245 DOI: 10.1093/ntr/ntx027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/19/2017] [Indexed: 11/14/2022]
Abstract
Introduction The Wisconsin Inventory of Smoking Dependence Motives (WISDM) is a multidimensional measure of smoking motives that was developed to facilitate research aiming to refine the nomological network surrounding tobacco dependence. Recent evidence suggests that a composite of four subscales, termed the Primary Dependence Motives (PDM), may represent core features of advanced addiction, while the remaining nine subscales (Secondary Dependence Motives; SDM) represent instrumental motives for cigarette use that may be relevant at any stage of smoking. Methods A sample of 255 smokers (all regular alcohol users) participated in an ecological momentary assessment study in which they monitored smoking behavior and related experiences for 21 days. Multilevel regression analyses tested how PDM and SDM predicted daily smoking rate, cigarette craving, and appraisals of pleasure and relief of unpleasant feelings from smoking. Results When PDM and SDM were entered simultaneously, only PDM was related to daily cigarette count, and only SDM predicted reports of craving and relief from unpleasant feelings from smoking. SDM was associated with reports of greater pleasure from smoking and PDM was associated with lower pleasure ratings. The Fagerström Test for Nicotine Dependence (FTND) was related to daily smoking rate and craving, but WISDM composites contributed incremental prediction. Conclusions The findings confirm that PDM indexes heavier use that is relatively unrelated to immediate consequences of smoking. SDM is not uniquely related to smoking heaviness, but is associated with craving and reports of pleasure and relief of unpleasant feelings derived from smoking during ad lib use. Implications This study extends the evidence for the distinction between the WISDM PDM and SDM. PDM scores are associated with heavier smoking and are relatively unrelated to immediate consequences of smoking. SDM is more strongly related to craving and reports of smoking-derived pleasure and relief of unpleasant feelings during ongoing use in daily life.
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Affiliation(s)
- Melissa E Tarantola
- Department of Psychological Sciences, University of Missouri, Columbia, MO.,Alcoholism Research Center at Washington University School of Medicine, St. Louis, MO
| | - Andrew C Heath
- Alcoholism Research Center at Washington University School of Medicine, St. Louis, MO.,Department of Psychiatry, Washington University School of Medicine. St. Louis, MO
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, MO.,Alcoholism Research Center at Washington University School of Medicine, St. Louis, MO
| | - Thomas M Piasecki
- Department of Psychological Sciences, University of Missouri, Columbia, MO.,Alcoholism Research Center at Washington University School of Medicine, St. Louis, MO
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Ditre JW, Kosiba JD, Zale EL, Zvolensky MJ, Maisto SA. Chronic Pain Status, Nicotine Withdrawal, and Expectancies for Smoking Cessation Among Lighter Smokers. Ann Behav Med 2017; 50:427-35. [PMID: 26813264 DOI: 10.1007/s12160-016-9769-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chronic pain and tobacco smoking are both highly prevalent and comorbid conditions, and chronic pain may pose a barrier to smoking cessation. PURPOSE The objective of this study was to test associations between chronic pain status and several smoking-related factors that have previously been shown to predict cessation outcomes. METHOD Daily smokers (N = 205) were recruited from the general population to complete an online survey of pain and tobacco smoking. RESULTS Results indicated that smokers with chronic pain (vs. no chronic pain) consumed more cigarettes per day, scored higher on an established measure of tobacco dependence, reported having less confidence in their ability to quit, and endorsed expectations for experiencing greater difficulty and more severe nicotine withdrawal during future cessation attempts. Mediation analyses further indicated that the inverse association between chronic pain and abstinence self-efficacy was indirectly influenced by past cessation failures. CONCLUSIONS These findings suggest that individuals with chronic pain may constitute an important subgroup of tobacco smokers who tend to experience lower confidence and greater difficulty when attempting to quit. Future research would benefit from replicating these findings among older and more diverse samples of heavier tobacco smokers, and extending this work to the study of prospective relations between chronic pain status and cessation-relevant processes/outcomes over the course of a quit attempt.
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.
| | - Jesse D Kosiba
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Emily L Zale
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
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LaRowe LR, Langdon KJ, Zvolensky MJ, Zale EL, Ditre JW. Pain-related anxiety as a predictor of early lapse and relapse to cigarette smoking. Exp Clin Psychopharmacol 2017; 25:255-264. [PMID: 28594195 PMCID: PMC5547034 DOI: 10.1037/pha0000127] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although emerging research suggests that pain-related anxiety may play a role in the maintenance of tobacco dependence, no previous work has examined pain-related anxiety as a predictor of smoking cessation outcomes. The current study aimed to test the hypothesis that pain-related anxiety would predict early lapse and relapse to cigarette smoking. These data were collected in the context of a primary study examining the role of emotional vulnerabilities in smoking cessation. The current analyses were conducted among 55 daily cigarette smokers who attempted to quit without psychosocial or pharmacological cessation aids. Pain-related anxiety was assessed at baseline using the Pain Anxiety Symptom Scale-20 (PASS-20). Early lapse and relapse were assessed using timeline follow-back procedures. Cox regression analyses indicated that pain-related anxiety was a significant predictor of both early smoking lapse and relapse such that for every 1-point increase on the PASS-20, the risk of early lapse increased by 3.7% and the risk of early relapse increased by 3.6%. These effects were evident above and beyond the variance accounted for by tobacco dependence, past 4-week pain severity, anxiety sensitivity, and the presence of current Axis I psychopathology. Kaplan-Meier survival analyses further revealed that among early lapsers, greater pain-related anxiety predicted a more rapid trajectory to lapse. Pain-related anxiety was also a significant predictor of early lapse when the sample was limited to smokers with past 4-week pain. These findings lend empirical support to the notion that pain-related anxiety may contribute to the maintenance of tobacco dependence among smokers who experience varying levels of pain intensity. (PsycINFO Database Record
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Ditre JW, Zale EL, Heckman BW, Hendricks PS. A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory. Cogn Behav Ther 2016; 46:339-351. [PMID: 27871214 DOI: 10.1080/16506073.2016.1256347] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.
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Affiliation(s)
- Joseph W Ditre
- a Department of Psychology , Syracuse University , 430 Huntington Hall, Syracuse , NY , USA
| | - Emily L Zale
- a Department of Psychology , Syracuse University , 430 Huntington Hall, Syracuse , NY , USA
| | - Bryan W Heckman
- b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Peter S Hendricks
- c Department of Health Behavior, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
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Zale EL, Maisto SA, Ditre JW. Anxiety and Depression in Bidirectional Relations Between Pain and Smoking: Implications for Smoking Cessation. Behav Modif 2015; 40:7-28. [PMID: 26467214 DOI: 10.1177/0145445515610744] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pain and tobacco smoking are highly prevalent and comorbid conditions that impose considerable burdens on individuals and health care systems. A recently proposed reciprocal model suggests that these conditions interact in a bidirectional manner, resulting in greater pain and the maintenance of tobacco addiction. Anxiety and depression are common among smokers in pain and have been identified as central mechanisms of interest. There is emerging evidence that smokers with anxiety/depression may experience more severe pain and functional impairment, greater pain-induced motivation to smoke, and increased sensitivity to pain during periods of smoking abstinence. Based on empirical findings, we hypothesize that these experiences may engender expectations that abstaining from smoking will exacerbate both pain and negative affect, thus eroding self-efficacy for smoking cessation and increasing perceived barriers to quitting. The goal of this narrative review is to examine the role of anxiety/depression in complex pain-smoking relations so as to advance evolving theoretical perspectives and inform the development of tailored interventions.
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Affiliation(s)
| | - Stephen A Maisto
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
| | - Joseph W Ditre
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
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Zale EL, Ditre JW. Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Curr Opin Psychol 2015; 5:24-30. [PMID: 25844393 DOI: 10.1016/j.copsyc.2015.03.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability.
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Goesling J, Brummett CM, Meraj TS, Moser SE, Hassett AL, Ditre JW. Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:1433-42. [PMID: 25801019 PMCID: PMC4765172 DOI: 10.1111/pme.12747] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes. METHODS Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia. RESULTS Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference. CONCLUSIONS Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge.
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Affiliation(s)
- Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor MI
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor MI
| | - Taha S. Meraj
- Medical School, University of Michigan, Ann Arbor, MI
| | | | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor MI
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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Ditre JW, Langdon KJ, Kosiba JD, Zale EL, Zvolensky MJ. Relations between pain-related anxiety, tobacco dependence, and barriers to quitting among a community-based sample of daily smokers. Addict Behav 2015; 42:130-5. [PMID: 25462660 DOI: 10.1016/j.addbeh.2014.11.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/21/2014] [Accepted: 11/19/2014] [Indexed: 11/18/2022]
Abstract
There is increasing recognition that complex and potentially bidirectional relations between pain and smoking may be relevant to the maintenance of tobacco addiction. Pain-related anxiety has been identified as a mechanism in the onset and progression of painful disorders, and initial evidence indicates that pain-related anxiety may be associated with essential features of tobacco dependence among smokers with chronic pain. However, there has not been an empirical study of pain-related anxiety in relation to tobacco dependence and self-reported barriers to quitting among a community-based sample of daily smokers. The current sample was comprised of 122 daily smokers who were recruited from the local community to participate in a larger study that included an initial assessment of pain, smoking history, and pain-related anxiety. Approximately 17% of our sample endorsed moderate or severe past-month pain, nearly half met criteria for current anxiety or mood disorder, and about 30% met criteria for a current substance use disorder, exclusive of tobacco dependence. Results indicated that pain-related anxiety was uniquely and positively associated with both tobacco dependence severity scores and self-reported barriers to quitting. These findings lend support to the notion that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers who experience varying levels of pain severity.
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Syracuse University, United States.
| | - Kirsten J Langdon
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, United States; Boston University School of Medicine, United States
| | - Jesse D Kosiba
- Department of Psychology, Syracuse University, United States
| | - Emily L Zale
- Department of Psychology, Syracuse University, United States
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